Impact of haemodialysis on insulin sensitivity of acute renal failure (ARF) patients with sepsis in critical care

摘要

Critically ill patients often develop renal failure in addition to their primary diagnosis. However, the effect and impact of haemodialysis (HD) on insulin sensitivity n critically ill patients remains unclear. Specifically, this study investigates insulin sensitivity of acute renal failure (ARF) patients with sepsis who underwent HD and glycaemic control. Model-based insulin sensitivity (S_I) profiles were identified for 20 critically ill ARF patients on Specialized Relative Insulin Nutrition Titration (SPRINT) glycaemic control during intervals onto HD (OFF/ON), and after HD (ON/OFF). Patients exhibited a median -18% (IQR -36% to -5% p<0.05) reduction in measured S_I after the OFF/ON dialysis transition, and a median 9% (IQR -5% to 37%, p<0.05) rise after the ON/OFF transition. Almost 80% of patients exhibited decreased S_I at the OFF/ON interval, and 60% exhibited increased S_I at the ON/OFF transition. Results indicate that HD commencement has significant effect on insulin pharmacokinetics at a cohort and per-patient level. These results provide the data to design conclusive studies of HD effects on S_I, and to inform glycaemic control protocol development and implementation for this specific group of critically ill patients with ARF-sepsis.